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Options for Care at Home

Experts: Having the right caregiver at home makes all the difference

By Ann Marie Cook and Elizabeth Zicari

Your mom needs care at home, but you work. What is the best way to find someone to help who is trustworthy, competent, kind and has the right training?

It’s a common question — the type of question anyone in the field of eldercare is asked often.

Trying to figure out home care options can feel overwhelming. Cost is often a key consideration, as is selecting the right skills and personality for your situation. Above all, you are entrusting a loved one’s care to another person. You are opening a home to that person. And, unfortunately, we know of instances of financial exploitation and other abuse by caregivers.

Home care has two components — skilled services, which includes nursing care and occupational/physical therapy; and custodial care, which includes help with daily living activities like bathing, dressing and eating.

You have two options for hiring. You can select an agency licensed by New York state or you can hire a private duty caregiver.

Both options have pros and cons.

In New York state, licensed and certified agencies provide both skilled (registered nurse, physician therapist, occupational therapist) and custodial care with home health aides. These agencies are regulated by the Department of Health and they have strict policies about screening, training and supervision.

Good agencies will work with you to ensure that the right caregiver is matched with your loved one to provide safe, effective and appropriate care. Home health aides employed by agencies have had background checks, drug screenings and are supervised by a registered nurse. Backup for illness and vacations should be provided. Such aides also are bonded, and aides working for an agency must be in a state registry.

Who pays for care? Skilled nursing care provided by a certified agency may be covered by Medicare or Medicaid under specific circumstances, and, if so, home health aide service may also be covered. When not covered by insurance, expect to pay an agency about $25-$30 an hour.

A private duty caregiver is someone you pay directly. You can find private caregivers through friends, your church and on online sites. By hiring privately, you get to choose who is in the home. But you’ll also need to do a full interview, completely check references and do a background check. Ask about experience with your loved one’s illness.

It is important to ask about experience with personal care. Know the difference between someone who simply provides companion care versus someone who can help with personal care.  Have a back-up plan to cover illness or vacation. Know that the IRS considers such arrangements to be employer/employee. You will be responsible for withholding and paying the appropriate taxes and for providing workers’ compensation insurance. Expect to pay $20 to $25 an hour for an experienced caregiver. Long-term care insurance will pay for privately-hired or agency-provided home care assuming eligibility requirements are met.

For situations like Alzheimer’s and Parkinson’s, where decline is inevitable, you must be prepared for changes in your loved one’s functioning that will require additional time and money.

Keeping a family member at home during an illness often isn’t easy and it’s rarely inexpensive. But if a family is committed to care at home, having the right caregiver(s) makes all the difference.

For information and non-biased information and guidance about eldercare, families in our community can call Lifespan at 585-244-8400.

Ann Marie Cook is president and chief executive officer at Lifespan in Rochester; Elizabeth Zicari is president of HCR Home Care, based in Rochester.